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A study of 101 gay men at the Fenway Health HIV clinic in Boston, USA (Politch) has found that a quarter of men with undetectable viral loads in their blood nonetheless had detectable HIV in their semen.

Although seminal viral load in these men was low (media 200 copies/ml), the researchers suggest that this is still enough to be one of the explanations for ongoing transmission in gay men despite a high proportion being on antiretroviral therapy.

There was a very strong association with detectable HIV in semen and having a current sexually transmitted infection (STI). Six of the eight men whose HIV was undetectable in blood but detectable in semen (so-called virally discordant) had a urethral STI. After adjusting for other factors the researchers concluded that men who had an STI and/or urethritis were 29 times more likely to have viral discordancy.

The fact that upwards of 20 some odd percent of HIV positive gay men at this clinic had a current STI is concerning. It shows how regular STI screenings are necessary. I know for me, my doctor really hasn't checked me for STI's unless I ask. I am sure others are similar. It's as if they run the routine cd4, viral load, and cbc's and are done with it "see ya in 6 months.". Guess I /we should be more demanding of getting routine screenings.

Although seminal viral load in these men was low (media 200 copies/ml), the researchers suggest that this is still enough to be one of the explanations for ongoing transmission in gay men despite a high proportion being on antiretroviral therapy.

I guess. But then, who are these HIV- guys who are choosing to take loads? Unanswered questions.

I get that the information is important for HIV+ guys to know.

But could this hypothesis about "ongoing transmission" be construed into a negative stereotype about HIV+ guys, that they are barebackers who don't know or, really, don't care they are transmitting HIV.

I mean I would wager most "ongoing transmission" in the gay world is from HIV+ guys who are not on treatment, and/or who don't know they are HIV+. And they are stumbling upon HIV- guys who are knowingly taking risks with people without asking if this partner who is going to shoot inside is HIV+.

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“From each, according to his ability; to each, according to his need” 1875 K Marx

I do wonder about this theory that undetectable gay men are the source of ongoing transmission. I guess in limited numbers. But ongoing transmission seems mostly to be a result of HIV- men making poor decisions and HIV+ men either not knowing they are, or knowing but not being on HAART.

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“From each, according to his ability; to each, according to his need” 1875 K Marx

But then, who are these HIV- guys who are choosing to take loads? Unanswered questions.

I get that the information is important for HIV+ guys to know.

Could they be HIV- and HIV+ guys who believe 100% in the grossly overstated premise that "treatment is prevention"?

Could they be an HIV- guy, who, when learning that their HIV+ partner is on antiretrovirals and has an undetectable viral load (by peripheral-blood measurement), believes there is no danger in barebacking?

« Last Edit: April 02, 2012, 07:42:57 PM by edfu »

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"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Could they be HIV- and HIV+ guys who believe 100% in the grossly overstated premise that "treatment is prevention"?

Could they be an HIV- guy, who, when learning that their HIV+ partner is on antiretrovirals and has an undetectable viral load (by peripheral-blood measurement), believes there is no danger in barebacking?

If the HIV+ guy is a bottom, then the detectable VL in semen is irrelevant. There are lots of rationalizations of "safe" barebacking in a serodiscordant relationship/act/whatever.

There are lots of rationalizations of "safe" barebacking in a serodiscordant relationship/act/whatever.

"safe barebacking" in a serodiscordant act is an oxymoron.

As an aside, the aidsmap article states:

"In the Boston study, participants were on average 43 years old and three-quarters were white. They had all been on antiretroviral therapy (ART) for more than three months and 80% for over a year.

Nearly three-quarters were judged as being at high risk of acquiring an STI because they had had unprotected sex in the last three months..............

Although seminal viral load in these men was low (media 200 copies/ml), the researchers suggest that this is still enough to be one of the explanations for ongoing transmission in gay men despite a high proportion being on antiretroviral therapy."

Does this mean that these guys partaking in the study admitted and accounted (to researchers) that they barebacked (after disclosing or not) with other guys who were of known HIV- status or of unknown status?

-If they did, these guys are (IMO) a reckless bunch (and quite stupid, I might add) and are not indicative of the wider poz community or gay community.

-If they didn't directly make such an admission then it seems like a questionable/ debatable conclusion (at the very least), that it is "one of the explanations for ongoing transmission in gay men despite a high proportion being on antiretroviral therapy".

The part that stuck out for me as well, "this is still enough to be one of the explanations for ongoing transmission in gay men despite a high proportion being on antiretroviral therapy."

I suppose the key words are "one of the explanations." We know most infections occur from people who don't know their status. So, I'm a little confused by this. We know there haven't been the kind of studies about serodiscordant sex in gay men, like we've seen in the straighties. So, they don't really know how many infections occur from gay, anal sex with the poz person on ARV's. I would think most people would read this like I did--poz folks are barebacking and infecting others at large enough numbers, despite being on meds.

No, not really. If you dissect the data you find that if the HIV positive partner does not have an STI then the percentage of undetectable gay men with HIV in their semen drops to 6%. Then, as Hellraiser brought up, what if the HIV positive person is the bottom?

In addition, this study really doesn't take into account a couple in a Serodiscordant relationship that maintains monogamy. They would be much less at risk of STI's and therefore at a low risk of transmission (especially if the HIV positive partner bottoms).

No, not really. If you dissect the data you find that if the HIV positive partner does not have an STI then the percentage of undetectable gay men with HIV in their semen drops to 6%. Then, as Hellraiser brought up, what if the HIV positive person is the bottom?

In addition, this study really doesn't take into account a couple in a Serodiscordant relationship that maintains monogamy. They would be much less at risk of STI's and therefore at a low risk of transmission (especially if the HIV positive partner bottoms).

This article has a slant of anti-gay Inferences IMHO

I totally agree with you about the 'irresponsible homosexual' slant of the article- it makes me a little scpetical about their findings.

I disagree that one can call 'serodiscordant barebacking' as safe. Safe sex is protected sex only.

The remoteness of passing on infection due to an undetectable viral load is not at all the same as knocking out the risk through condom use.

Anyway its interesting news about the loaded loads. But didn't we know that already. But it is interesting because its a counterweight to the Swiss Statement and it does effectively question the rationalization creep that has gay HIV+ men applying the Swiss Statement to their own sexual practices, when in fact the Swiss Statement clearly was about a different group of people.

« Last Edit: April 03, 2012, 04:03:49 AM by mecch »

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“From each, according to his ability; to each, according to his need” 1875 K Marx

If that's the correct assumption (and does not mean that they were having sex with guys who were of known neg/unknown status) then their finding that "this is still enough to be one of the explanations for ongoing transmission in gay men despite a high proportion being on antiretroviral therapy"- does not hold water according to me.

If on the other hand, they do mean that these pozzies were having unprotected sex with neggies/ untested people, then I have a slight problem with them extrapolating these results to the larger gay community. (Maybe I'm wrong, but that's how I feel).

Miss P, just said it was an unanswered question about the data. It could be interpreted as biased, which is not saying the author meant it that way. Its just a tangential side point to the data. Thats what I felt when I read the article so I expressed it.

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“From each, according to his ability; to each, according to his need” 1875 K Marx